Individual provider Active NPI

Leo Michael Michalek Jr., MD

  • General Practice Physician
  • Hamburg, NY
National Provider Identifier
1003801366
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
094920 Issued in NY
Practice address
6946 E Eden Rd
Hamburg, NY 14075-6408
Phone
(716) 649-5180
NPI assigned
Sep 13, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 094920 NY Primary

Addresses

Primary practice location

6946 E Eden Rd
Hamburg, NY 14075-6408

Mailing address

6946 E Eden Rd
Hamburg, NY 14075-6408
Phone (716) 649-5180

Other identifiers 4

IdentifierTypeStateIssuer
00601643MedicaidNY
000505334001OtherBCBS
1700291OtherIHA
00010118401OtherUNIVERA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100602000458 NY Practitioner - General PracticePractitioner - General Surgery 1759410608 Practice locations: West Seneca, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
094920NYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michael P Rade MD PC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1003801366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6946 E EDEN RD",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140756408",
            "telephone_number": "716-649-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6946 E EDEN RD",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140756408",
            "telephone_number": "716-649-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHALEK",
        "first_name": "LEO",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "094920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00601643",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000505334001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "1700291",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00010118401",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamburg, NY

Sources for this page

Verify at the official NPI Registry.